Womens Health Flashcards
1
Q
Fibrocystic Breasts
A
Excessive cellular growth in breast ducts, lobules and connective tissues (Benign breast tumors)
2
Q
causes of fibrocystic breasts
A
Responsive to repeated monthly stimulation of the breast tissue by estrogen and progesterone: degree & amount of nodularity is highly individualized
3
Q
Premenstrual:
ht
A
-pay attention to monthly changes
-small nodules
-painful
-size change occurs with menstrual cycle
4
Q
Palpable Nodule:
- Lump
when to call HCP
A
one or more
round
well delineated
freely moveable
self breast examination(SBE) should note change in size
Lump: if new lump does not change in size with menstrual cycle - Have checked by HCP
5
Q
Fibrocystic Breasts: Treatment
A
-Mammogram/Ultrasound- 1st step in diagnosis
-Aspiration of Nodule:
removal of fluid through needle aspiration – pathology to look at cells/fluid
-Biopsy of Nodule:
for women with history of breast cancer
6
Q
Low Na+ Diet:
A
decreases swelling and pain in breasts
7
Q
Decrease Caffeine:
A
Health teach sources of caffeine
8
Q
Vitamin E
A
may be beneficial in relieving swelling in breasts-200 IU bid to tid
9
Q
Danazol (Danocrine):
A
synthetic form of testosterone - may be prescribed for severe symptoms-side effects
10
Q
PMS symptoms:
A
B Vitamins esp.Vitamin B6; 50 mg. day 1-14 menstrual cycle; 100mg d 15-end; plus diet changes
11
Q
Chocolate cravings mid cycle:
A
Magnesium 250 mg q day may control cravings
12
Q
Wear Supportive bra
A
reduces swelling
13
Q
Breast Cancer
A
malignant growth of breast cells involving a localized area of breast tissue, lymph nodes, and skin
14
Q
Familial-
A
first-degree relative had breast, ovarian, or pancreatic
Cancer ( mother, sister, daughter )
15
Q
Inherited-
A
mutations in BRCA #1 or BRCA #2 genes (Up to 10 %
women)
16
Q
Hormone Levels-
what kind of bpdy type produces increased
A
risk increases for high estrogen levels for much of life; more than 25% body fat- fat makes estrdil
17
Q
Decreasing Risk Potential
A
Have children early & breast feed
Maintain weight
Decrease weight if overweight
Type of dietary fat intake
Exercise
Avoid Drinking alcohol
18
Q
Preventive Meds & Treatment
for High-Risk Women
medications3/ one is procedure
A
Tamoxifen
Raloxifene (Evista)
Anastrozole (Arimidex) Aromatase inhibitor.
Prophylactic Mastectomy
19
Q
Tamoxifen (Common brand names: Nolvadex, Soltamox)-
A
Tx advanced BC w/surg and prophylactic treatment of BC
Estrogen receptor Blockers
Action- estrogen antagonist for receptor sites in tissues; competitive inhibitor for estrogen
Side Effects: hot flashes, rash, N/V/vaginal bleeding, thrombus
20
Q
Raloxifene (Evista)
A
Estrogen receptor modulators (Not hormones, effect receptor sites)
Action-estrogen antagonist in breast tissues
Side Effects-venous thromboembolism, hot flashes skin rash, N/V, vaginal bleeding, PE, Stroke
21
Q
Anastrozole (Arimidex) Aromatase inhibitor.
A
These are a class of medicines that work by blocking the enzyme aromatase, the enzyme that converts androgens into estrogen.reduces risk of invasive BC in high risk postmenopausal women
Side Effects- Hypertension, Gastrointestinal irritation, Drug-induced hot flash, Skin rash, N/V/D, edema
22
Q
Prophylactic Mastectomy-
A
to reduce the risk of BC in those who are at high risk; lowers risk by 90% (Those with BRCA1 and/or BRCA2 among other mutations)
23
Q
BRCA 1 and BRCA 2
A
Human genes that produce tumor suppressors
Genes can mutate- some mutations can be harmful
24
Q
Women with BRCA mutations are at a higher risk for
4
A
Ovarian, colon, pancreatic and uterine cancer
25
Men with BRCA mutations are higher at risk for
| 4
breast, pancreatic, testicular, prostate
26
Dimpling in breast
(Peau d’orange- not inverted nipple)
27
Noninvasive breast cancer
Ductal (DICS-in the milk duct) carcinoma in situ (in its original place)
Intraductal cancer: it hasn’t spread to any other place
28
s/s of breast cancer
Palpation of mass during self breast exam (upper outer quad)
Non tender, non movable mass
Dimpling in breast (Peau d’orange- not inverted nipple)
Nipple discharge (usually benign however should be investigated)
Change in shape of breast (asymmetrical)
Skin ulceration or redness, heat or swelling anywhere on breast
Enlargement of axillary, supraclavicular or cervical lymph nodes
29
Paget’s Disease of The Breast
s/s:
treatment:
prognosis:
Signs and Symptoms: Itching, burning, bloody discharge with superficial erosion or ulceration. Misdiagnosed frequently as infection or dermatitis with or w/out sentinel node biopsy
Treatment: Simple or Modified radical mastectomy, Radiation after surgery
Prognosis:
Usually good if the cancer is confined to the nipple
30
Inflammatory
s/s:
Rare, aggressive, fast growing breast cancer. Lymph channels of the of breastbone become blocked by cancer cells
Breast edema, erythema in 1/3 of the breast
Oftentimes it’s misdiagnosed as eczema or dermatitis
Rapid onset: redness, warmth and thickened appearance of skin,
peau d’orange resembling orange peel
31
Screening
Should be done at the same time during cycle every month
Mammogram: beginning age 40 (ACS)
- Dense breasts; ultrasound
32
SBE-
Same period every month (middle) of the menstrual cycle. No Cycle? Same time every month (i.e. second Tuesday of the month)
Axillary & supraclavicular lymphadenopathy
-upper outer quadrant
33
Skin-
| sign of cancer
hard, irregular non-movable breast lump upper outer quad., Thickening of breast, Nipple inversion or retraction, redness, warmth
34
Abnormal mammogram-
The radiologist will look for areas of white, high-density tissue and note its size, shape, and edges.
35
Thermogram-
On a thermogram image, “hot spots” appear red compared to surrounding tissue that appears yellow, green or blue. Anything that is causing an inflammatory response from the body will show up on a thermogram image as hot.
36
MRI-
False + used for inflammatory BC; NOT for women at average risk
37
Biopsy of Breast
Fine-needle aspiration biopsy (FNAB)
Sentineal
Stereotactic biopsy
Core needle biopsy (CNB):
Vacuum-assisted biopsy (VAB):
Surgical (excisional) biopsy:
Fine-needle aspiration biopsy (FNAB): Involves using a thin needle to remove cells or fluid from a lump or mass in the breast. NO CUTTING , fluid from cyst.
Sentineal Node: with dye. to see how far tumor has spread.
Core needle biopsy (CNB): Utilizes a larger needle to remove several small cylinders of tissue from the breast lump or abnormal area.
Vacuum-assisted biopsy (VAB): Similar to CNB but uses a vacuum-powered device to collect multiple tissue samples with a single insertion of the needle.
Surgical (excisional) biopsy: Involves the surgical removal of the entire lump or abnormal area along with a margin of surrounding normal tissue for examination.
38
Diagnosis
Estrogen and progesterone receptor assay of the tissue-hormone receptors on tumor
HER-2 (human epidermal growth factor receptor) Increased risk of reoccurrence of BC and poor prognosis-tend to be aggressive
CEA (carcinoembryonic antigen); blood work-how adequate is tx and /or tumor reoccurrence
CA15-3– useful in monitoring patient response to therapy for metastatic BC
39
void
void
40
Radical mastectomy-
Radical mastectomy is a surgical procedure that treats breast cancer by removing the breast and its underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla (armpit)
41
Axillary lymph node dissection-
There are three levels of axillary lymph nodes (the nodes in the underarm or "axilla" area. A traditional axillary lymph node dissection usually removes nodes in levels I and II. For women with invasive breast cancer, this procedure accompanies a mastectomy. It may be done at the same time as, or after, a lumpectomy (through a separate incision).
42
High-Dose Brachytherapy
Radiation delivered directly into the cavity left after tumor removal
Internal radiation delivered using a Mult catheter implant (now balloon brachytherapy)
After placement, radioactive seed delivered into each catheter to tx target area
Traditional radiation takes approximately 5 to 6 wks – internal radiation + 5 days
43
Radiation Therapy
Usually after surgery
Decision based on probability of residual cancer cells present
Traditional whole breast radiation is 5 days per week for 5-7 weeks
Temporary side effects – fatigue, skin changes and breast edema
44
Chemotherapy
Cytotoxic drugs to kill cancer if spread
Usually a combination of drugs
Usually given 3-6 months but if metastasis, maybe rest of life
45
Hormonal Therapy
Blocks estrogen; tumor regression
Tamoxifen, raloxifene (Evista), anastrozole (Arimidex)
46
Biologic Therapy
Treatment with drugs that change the way cancer cells interact and stops cancer cells sending signals that make them divide and grow.
Trastuzumab (Herceptin) a monoclonal antibody binds w/HER-2neu protein
47
Impaired Lymphatic Drainage-
During surgery for cancer, nearby lymph nodes are often removed. This disrupts the flow of lymph, which can lead to swelling (Lymphoedema)
48
Emotional Aspects-
Breasts are symbol of beauty, sexuality, femininity-significant psychologic, social, sexual and body image implications associated with BC removal
Hemovac or JP drains
49
Use of Prosthesis
done 4-8 weeks after surgery
50
After an
Axillary Node
Dissection
Lymphedema
(ALND)
NO
BP, Venipunctures, Injections on affected arm. Avoid injuring arm
Tx: Lymph Massage, Compression Sleeve
51
Post-op Exercises
Arm and Shoulder Mobility Exercises: Gentle arm and shoulder movements can help prevent stiffness and improve range of motion. These may include shoulder shrugs, shoulder rolls, arm circles, and pendulum swings.
Breathing Exercises: Deep breathing exercises can help prevent complications such as pneumonia and aid in relaxation. Encourage deep breaths in through the nose, holding briefly, and then exhaling fully through the mouth.
Scapular Retraction: This exercise involves squeezing the shoulder blades together while keeping the shoulders relaxed. It helps to improve posture and strengthen the muscles around the shoulder blades.
Wall Climbing: Standing facing a wall, walk your fingers up the wall as far as you comfortably can, then walk them back down. This exercise helps to improve shoulder flexibility and strength.
Pectoral Stretch: Stand in a doorway with your hands on the door frame at shoulder height. Lean forward slightly until you feel a stretch in the chest muscles. Hold for 15-30 seconds and repeat several times.
Lymphatic Drainage Exercises: These exercises are designed to encourage lymphatic fluid movement and reduce swelling. They may include gentle massage, elevation of the affected arm, and specific movements guided by a therapist.
52
Breast Augmentation:
(enlarging breasts) Surgically created pocket between breast and pectoral fascia, or under pectoral muscle
53
Reduction-
lg breasts can cause pain, done by resecting wedges of tissue from upper and lower quads of breast
Excess skin removed
Areola and nipple relocated
54
1 stage-
implant inserted at same time as mastectomy
55
2 stage-
tissue expander inserted after mastectomy- expander removed permanent implant placed or remains in place and becomes implant
56
A musculocutaneous flap
is a surgical technique used in reconstructive procedures. It combines both muscle tissue and overlying skin.
57
Nipple/Areola Reconstruction-
more natural appearance skin taken from flap on affected side or other side or tattooed on
58
Drains can be placed to prevent...
prevent hematomas (JP; Hemovac)
59
Begins in the epithelial cells lining the mammary ducts and its rate of growth depends on:
Estrogen
Progesterone
Human Epidermal Growth Factor Receptors 2 (HER2)
60
Triple Negative (TNBC) –
estrogen receptor-negative, progesterone receptor-negative, HER2-negative; more aggressive and lower survival rate
61
Arm exercises QID to the point of pain
1st –
2nd –
3rd –
1st – clench & extend fingers
2nd – wrist & elbow
3rd – arm
62
Sentinel Lymph Node Biopsy:
sentinel node is the 1st to receive lymphatic drainage from the tumor and it’s identified by injecting blue dye & radioactive dye and later sent to pathology for tumor cells
63
HER-2 (human epidermal growth factor receptor)
marker increased risk of reoccurrence of BC and poor prognosis-tend to be aggressive
64
CEA
(carcinoembryonic antigen); blood work-how adequate is tx and /or tumor reoccurrence
65
CA15-3–
useful in monitoring patient response to therapy for metastatic BC
66
Breast Augmentation:
(enlarging breasts) Surgically created pocket between breast and pectoral fascia, or under pectoral muscle
67
Reduction-
lg breasts can cause pain, done by resecting wedges of tissue from upper and lower quads of breast
Excess skin removed
68
Timing r/t mastectomy-
Expected result-
Procedure:
1 stage-
2 stage-
may be done during mastectomy or sometime afterward based on pt.’s physical and psychological needs
improve self image, sense of normalcy, coping and contour of breast w/o external prosthesis.
1 stage- implant inserted at same time as mastectomy
2 stage-tissue expander inserted after mastectomy- expander removed permanent implant placed or remains in place and becomes implant
69
A musculocutaneous flap
is a surgical technique used in reconstructive procedures. It combines both muscle tissue and overlying skin.
70
Nipple/Areola Reconstruction-
more natural appearance skin taken from flap on affected side or other side or tattooed on.
71
Check drains for
excess blood or odor
Change dressings as needed
Assure patient that the appearance will improve
Wear good support with a bra or band
No strenuous activity for 2-3 weeks
72
TISSUE EXPANDER
GRADUALLY STRETCHES SKIN
73
TRAM Flap
The abdominal tissue, while attached to the rectus muscle, nerve and blood supply, is tunneled through the abdomen to the chest
74
PELVIC INFLAMMATORY DISEASE
causes
s&s
treatment
Acute or chronic inflammation of the female reproductive organs
Cause: various microorganisms
S&S: Sharp pain, elevated temperature, copious purulent vaginal discharge, nausea, malaise, dyspareunia
Treatment: Antibiotics, no intercourse, rest, nutrition, possible isolation
75
Uterine Prolapse
define:
cause:
s&s
Dx:
treatment:
Definition: uterus to sounds downward into vagina, may be externally visible
Cause: weakening of pelvic supports, childbirth, aging, congenital weakness, and increased pressure
Usually accompanied by: cystocele (bladder), rectocele (Rectum) urethra may be pulled down or out of position
S&S: feeling of something "coming down”, dyspareunia, pelvic pressure, backache, elimination difficulties esp. stress incontinence
Dx: Based of S&S, pelvic exam
Treatment: prevention best, kegals, Pessary, Anterior/Posterior repair, vaginal hysterectomy
76
Colporrhaphy:
suturing of vagina wall to tighten muscle floor (anterior/posterior)
77
Marshall-Marchetti
bladder suspension (bladder sling
78
A&P repair:
both bladder and rectum
79
Hysterectomy:
usually vaginal
80
A Cystocele
bladder into vagina
81
B Rectocele
bladder into anus
82
Pessary
prosthetic device inserted into the vagina f
83
Bladder Fistula
define:
s/s:
treatment:
A bladder fistula happens when an irregular skin connection forms between the bladder and another organ. Though rare, a bladder fistula to the skin can result when the bladder outlet is blocked, and the bladder is damaged. This can be due to injury or prior surgery.
S/S: urine smelling or looking like stool or if gas comes out through your urethra when pt. urinates
Treatment: most often treated with surgery to remove the damaged part of the bladder
84
Vaginal Fistula
S/S:
Excoriation, Infection
Odor
May see flatus, stool or urine from vagina
Nursing:
Hygiene needs: needs to be kept clean, sitz baths, change peri-pads often
Post-op needs: foley catheter, needs fluids, strict asepsis, reduce pressure on area, stool softeners, etc.
85
UTERINE FIBROIDS (Leiomyomas)
most common benign tumor
slow growing
hormone
dependent
Decrease post-menopause
Causes: Overgrowth of connective tissue/muscle, most common in women over 35, Nulliparous or para1
86
Signs and symptoms
Uterine Fibroids
Metorrhagia vs Menorrhagia
Metrorrhagia
Uterine bleeding other than that caused by menstruation. Bleeding/spotting btw periods.
Menorrhagia
Increased duration of and/or increased amount of bleeding
Anemia related to blood loss
Pelvic pain
Lower abdominal enlargement or heaviness
Urinary retention
Inability to conceive/maintain pregnancy
87
Treatment Fibroids
Dilatation and curettage (D & C)
Myomectomy-removal of fibroid area of myometrium
Uterine artery embolization ; interventional radiology
88
ExAblate
combines two systems--a magnetic resonance imaging (MRI) machine to visualize patient anatomy, map the volume of fibroid tissue to be treated, and monitor the temperature of the uterine tissue after heating, and a focused ultrasound beam that heats and destroys the fibroid tissue using high frequency, high-energy sound waves. This is the first time these two systems have been combined and the first time MR has been used to monitor tissue temperature. The treatment requires repeated targeting and heating of fibroid tissue while the patient lies inside the MRI machine. The procedure can last as long as three hours.
89
Ablation
90
ENDOMETRIOSIS
cause:
diagnosis:
treatment:
drug therapy:
Cause unknown Inc estrogen & progesterone=inc cell growth
Diagnosis: rule out ectopic pregnancy, ovarian cysts, cancer, fibroids then a laparoscopy
Treatment: reverse disease, alleviate pain, restore fertility if necessary, contingent on age, peritoneal scaring, severity of S&S
-Conservative keeps reproductive organs intact
-Definitive is a total abdominal hysterectomy with a bilateral salpingo-oophorectomy
Drug Therapy; Depo-Provera, danazol, Gonadotropin releasing hormone agonists-stops production of sex hormones-Lupron Depot (leuprolide acetate)
91
Endometrial Cancer
risk factors
s/s
dx
treatment
Risk Factors
Women over 50 years old
Women who are obese, diabetic, hypertensive and nulliparous
History of metrorrhagia
Unopposed estrogen use
Signs & Symptoms
Uterine bleeding unrelated to menses “post menopausal bleeding”
Pain (late symptom)
DX: H & P, Endometrial biopsy, pap smear R/O Cervical CA
Treatment: Hysterectomy, radiation P surg,
Hormone tx, Chemo
92
Cervical Cancer
risk factors
s/s
Most common in women 30-50 years old
Early, frequent intercourse
Multiple sexual partners
HPV virus associated with 90-95% of cervical cancer
Untreated chronic cervicitis
Smoking
Signs and Symptoms
Watery vaginal discharge
Progresses as disease progresses
Vaginal bleeding
Spotting after intercourse or douche
Spotting heavier, more frequent as tumor become larger
Advanced:
Pressure, rectal discharge, pain, perineal fistula
93
Cervical Cancer Diagnosis
Pap smear
ACS-Not until 21 yo or 3 yrs p first intercourse
CIN – cervical intraepithelial neoplasia
Cervical biopsy
History & Physical
Schiller Test – Iodine solution applied
to cervix
Colposcopy – magnifying lens
Treatment: hysterectomy, chemo & radiation after
surg,.LEEP, Pelvic exenteration
94
Gardasil-
prevention HPV
Total exenteration
95
Hysterectomy Kinds:
Subtotal –
Total –
Salpingectomy –
Oophorectomy –
BSO –
TAH –
Post –
Subtotal – uterus removed
Total – uterus and cervix
Salpingectomy – removal of fallopian tube
Oophorectomy – removal of ovary
BSO – bilateral salpingectomy
TAH – total abdominal hysterectomy
Post – hysterectomy sexuality
96
Risk Factors for ovarian CA
> 65 yo
Menstrual periods; before age 12 & after age 50
Fertility drugs
BRCA 1 & BRAC 2
Hx breast cancer
Estrogen replacement therapy
Talcum powder
97
Prevention of ovarian
Pregnancy & breastfeeding
ASA (?)
Prophylactic oophorectomy
Nursing Management: Suportive, TCT, care of pt. w abdominal surg, HT meds, tx,
Support for radiation and chemo
98
watch out for s/s of ovarian
Vague
GI symptoms
Unusual bleeding
Back or leg pain
99
Menopause
Complete after 1 year of amenorrhea
100
Decreased Estrogen
Vasomotor instability –
Causes the S&S of menopause
Occurs because of fluctuating hormones
Atrophy changes with vagina/urethra
Thinning of epithelium
Vaginal dryness
Painful sexual intercourse
Coronary Heart Disease
Osteoporosis
Prevention – weight bearing exercise
Calcium supplements
Raloxifene
101
Osteoporosis
Weight-bearing exercise
Calcium/Vit D supplements 1200-1500 mg
Medications:
Raloxifene
Targets sites
May inc hot flashes
May dec risk of BC
More in NUR 211
102
Hormone therapy
Use of estrogen alone or in combination with progesterone
Started to cope with s&s of menopause(hot flashes, insomnia, vaginal discomforts, drop in libido, mood swings
Controversy over results of study by women’s health initiative-increased risk breast cancer, stroke, heart disease, DVT/PE
New studies, re-evaluation WHI
Decision to use based on history, risks & severity of S&S
Recommendation: lowest dose shortest amt of time
103
Four ways to take estrogen
1. pills-estrogen alone or combination estrogen/progestin
2. Estring-soft flexible ring inserted into vagina (sexual comfort, urinary urgency & pain; very little estrogen gets in bloodstream)
3. Creams-vaginal dryness, sexual comfort
4. Patches-as effective as pill for osteoporosis and heart
104
LIPOSUCTION
crushing, then removing fat cells
Large amounts of fluid injected into areas treated or suction curettage to remove excess fat for body contouring
105
Congenital:
Catastrophic:
Cancer:
Cosmetic:
Congenital: cleft lip/palate
Catastrophic: burns/skin grafts
Cancer: removal of tumor. May need reconstruction, skin grafting
Cosmetic: looking good/ our perception of looking good
106
RHINOPLASTY/SEPTOPLASTY
MAY BE PERFORMED FOR COSMETIC REASONS OR TO IMPROVE AIRWAY FUNCTION.
Semi-Fowlers for 2 days to decrease swelling ( at least 40 degrees for swelling to go down)
DONT Bend down will cause more oozing
107
RHYTIDECTOMY/RHYTIDOPLASTY
Surgical excision of facial wrinkles and soft tissue folds
Chemical Face Peeling
Dermabrasion
